Why are conditions affecting up to one in five women still being dismissed, misdiagnosed, or left untreated in mainstream healthcare?
Dr. Tania Adib is a leading London-based gynaecologist specialising in vulvar health. This is the first episode of the podcast - a foundational deep dive into vulvodynia and vaginismus with a clinician who has spent her career at the intersection of women's health and conditions that most of medicine has been slow to take seriously. The episode covers the four key root causes of vulvar pain, the diagnostic challenges that keep so many people in limbo, and what is actually available in terms of treatment - including what's coming next.
Why vulvodynia and vaginismus are still being dismissed - and who is paying the price
Vulvodynia and vaginismus are estimated to affect up to one in five women, yet they remain among the most under-diagnosed and under-treated conditions in women's healthcare. Dr. Adib explains why: a combination of inadequate training in medical education, cultural shame that prevents both patients and practitioners from speaking plainly about vulvovaginal pain, and a research funding gap that has kept the evidence base thin relative to the scale of the problem. The result is a system that routinely fails the people who need it most.
The consequences of this failure are documented in the stories of people who spend years - sometimes decades - being told their pain is psychological, stress-related, or normal. Dr. Adib is clear that this is not acceptable and that it is changing, albeit slowly. Understanding what you are entitled to ask for, and what a proper assessment looks like, is part of what this episode provides.
"These conditions affect a huge number of women. The fact that they are still being dismissed so frequently is a failure of medical education, of research funding, and of the culture around women's pain."
The four root causes: hormonal, muscular, neurological, and inflammatory
Dr. Adib organises her framework for vulvar pain around four key root-cause categories. Hormonal factors - including the effects of contraceptive pills on the vaginal vestibule, low oestrogen states, and cyclical hormonal fluctuation - are both common and responsive to targeted treatment. Muscular causes involve the pelvic floor and the pain cycles that develop when tension and pain reinforce each other. Neurological factors involve peripheral nerve sensitisation and, in some cases, central sensitisation. Inflammatory drivers include vestibulitis and other immune-mediated processes.
In practice, these categories overlap. A patient may have hormonal and muscular drivers contributing simultaneously, and effective treatment needs to address both. Dr. Adib discusses how she assesses which factors are present and how treatment sequencing works - what to address first, what needs to be done in parallel, and when specialist referral is warranted.
"The four root causes often stack on top of each other. That's why you can treat one and still not get better - because the other drivers are still active."
Hormonal contraception and the menstrual cycle: connections most people aren't told about
The potential link between hormonal contraception and vulvodynia is one of the most practically important and under-discussed topics in this space. Dr. Adib explains the mechanism: certain oral contraceptives can reduce androgen levels in vaginal tissue, altering the tissue quality of the vestibule in ways that increase pain sensitivity. Not everyone who takes the pill is affected, and the relationship is not fully characterised - but for women whose pain began or worsened after starting hormonal contraception, this is a line of investigation worth pursuing.
She also covers how symptoms can fluctuate across the menstrual cycle - something that many patients notice but aren't sure how to interpret or communicate to their practitioners. Understanding this cyclical pattern is clinically relevant and can help identify the hormonal drivers that are most likely to respond to treatment.
What a proper diagnosis looks like - and what treatments are available
Dr. Adib describes what a thorough assessment of vulvodynia or vaginismus should include - the history, the examination, and the investigations that help identify root causes rather than just the presence of pain. For people who have had appointments that fell short of this standard, understanding what they are entitled to ask for changes how they approach the next one.
She also covers the treatment landscape: topical hormones, pelvic floor physiotherapy, pain medications, nerve blocks, and what the research currently supports for each. For people at the beginning of navigating treatment - or who have been through treatments that haven't worked and don't know what to try next - Dr. Adib's overview is a clear, clinical map of the territory.
